Biologically reabsorbable acetabular constraining components and materials for use with a hip replacement prosthesis and bioreabsorbable materials to augment hip replacement stability and function

ABSTRACT

A prosthetic constraining device for use with a hip replacement prosthesis that includes an acetabular cup assembly adapted to be bonded to a patient&#39;s pelvis and a femoral stem adapted to be bonded to the patient&#39;s femur, where the femoral stem includes a ball component at its proximal end received within the acetabular cup assembly to form a ball joint type coupling, and where the constraining device includes a ring having a central aperture, where the ring is adapted to be mounted to a rim of the acetabular cup assembly so that the femoral stem passes through the central aperture, where the diameter of the central aperture is less than the diameter of the ball component on the proximal end of the femoral stem so that the ring assists in maintaining the ball joint type coupling between the acetabular cup assembly and the femoral stem, and where the ring comprises a biologic material, a biologically reabsorbable material and a combination of biologic, or biologically reabsorbable materials.

REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of U.S. ProvisionalApplication Serial No. 60/371,058, entitled “BIOLOGICALLY ABSORBABLEACETABULAR CONSTRAINING COMPONENTS AND MATERIALS FOR USE WITH A HIPREPLACEMENT PROSTHESIS AND BIOABSORBABLE MATERIALS TO AUGMENT HIPREPLACEMENT STABILITY AND FUNCTION”, filed on Apr. 9, 2002, thedisclosure of which is incorporated herein by reference.

BACKGROUND

[0002] 1. Field of the Invention

[0003] The present invention is directed toward constraining componentsfor use with joints of the body. Examples of such joints include hipjoints, shoulder joints, elbow joints, and ankle joints. Morespecifically, aspects of the present invention are directed towardbiologic and biologically reabsorbable acetabular constrainingcomponents to at least temporarily augment the stability and function ofthe joint after repair or replacement surgery.

[0004] 2. Background of the Invention

[0005]FIG. 1 illustrates a prior art hip replacement prosthesis whichincludes an acetabular cup/shell 10 bonded to the pelvis 12 of a patientand a femoral component 14 or stem bonded to the patient's femur 16where the acetabular cup/shell 10 and femoral component 14 are coupledtogether with a ball joint-type coupling 18. FIG. 2 illustrates a sideview of the acetabular shell 10 bonded to the patient's pelvis 12. Theacetabular shell includes a polyethylene, metal, or ceramic insert 20seated therein.

[0006] A frequent complication with prior art hip replacement prostheticcomponents is dislocation of the ball 22 of the femoral component 14from the acetabular shell 10. Prior art attempts to overcome thisproblem utilize constraining mechanisms, such as locking rings. However,such constraining mechanisms may tend to limit hip range of motionpermanently, may not allow for normal pari-articular scarring to occurto optimize long-term hip stability and range of motion, and may alsoincrease stress transmission to the fixation interfaces of theacetabular shell 10 over time promoting mechanical breakdown of ingrowthor cement and/or locking mechanism failure between the acetabular shell10 and polyethylene insert 20 resulting in backside acetabular wear.

SUMMARY

[0007] The present invention is directed to constraining devices thatassist in inhibiting dislocation of a ball aspect of a prosthetic hipjoint after surgery. Certain aspects of the present invention aredirected to the use of a constraining mechanism for a prosthetic hipimplant that is made of biologic and/or biologically reabsorbablematerial affixed between the acetabular cup and the femoral component ofa hip prosthesis. Further aspects of the present invention are directedtoward the use of biologic and/or biologically reabsorbable material toincrease the rate of tissue formation (such as scar tissue formation)and subsequent time to host stability about the total hip replacement.Further aspects of the present invention are directed to the use of abiologic and/or biologically reabsorbable paste or glue material (eitheralone or in combination with any of the above aspects) to increase therate of scar tissue formation and subsequent host stability about thehip joint after total hip replacement. Further aspects of the presentinvention are directed to the impregnation of helpful agents to any ofthe above biologic and biologically reabsorbable materials such as aclotting agent, a scarring agent, a preventative bone formation agent(anti-heterotopic ossification), a non-steroidal anti-inflammatory drug(NSAID), and/or an antibiotic. Further aspects of the present inventionare directed to the use of a biologic and/or biologically reabsorbablestabilizer that could span from the acetabulum and be fixed to the neckof the femoral component to act like a rubber band allowing motion ofthe femoral component while eventually scaring to provide permanentstability, used alone or in combination with any of the other aspectsdescribed above. Further aspects of the present invention are directedto the use of biologically reabsorbable screws or other fasteners toattach a constraining mechanism to the acetabular cup/shell (used eitheralone or in combination with any of the above aspects). Further aspectsof the present invention are directed to the use of biologicallyreabsorbable mesh or webbing to retain the femoral component to theacetabulum or acetabular cup/shell component, used either alone or incombination with any of the above aspects.

[0008] Particular embodiments make use of constraining rings havinggeometries that are specifically adapted to provide the range of motiondesired by patients after surgery, but with the additional benefit ofdoing so without substantially increasing the risks of impingement onthe femoral component neck at the extremes of motion or dislocation andadditional surgery to repair the dislocation. At least one of theexemplary embodiments utilizes a biologically reabsorbable material totemporarily inhibit such dislocation, allowing the physician to positionand/or rotate the constraining device to reduce impingement and increasethe available range of motion desirable in at least one axial direction.In such an embodiment, it is envisioned that the biologicallyreabsorbable material degrades in general proportion to the level oftissue developed by the patient's own body to supplement stability ofthe hip joint and inhibit dislocation. Thus, as the patient's need foran artificial constraining device decreases, so too does the artificialconstraining device itself.

[0009] It is an aspect of the present invention to provide a prostheticconstraining device for use with a hip replacement prosthesis thatincludes an acetabular cup assembly adapted to be bonded to a patient'spelvis and a femoral stem adapted to be bonded to the patient's femur,where the femoral stem includes a ball component at its proximal endreceived within the acetabular cup assembly to form a ball joint typecoupling, and where the constraining device includes a ring having acentral aperture, where the ring is adapted to be mounted to a rim ofthe acetabular cup assembly so that the femoral stem passes through thecentral aperture, where the diameter of the central aperture is lessthan the diameter of the ball component on the proximal end of thefemoral stem so that the ring assists in maintaining the ball joint typecoupling between the acetabular cup assembly and the femoral stem, andwhere the ring comprises a biologic material, a biologicallyreabsorbable material or a combination of biologic, and biologicallyreabsorbable materials.

[0010] It is a second aspect of the present invention to provide aprosthetic hip prosthesis that includes: an acetabular cup assemblyadapted to be bonded to a patient's pelvis; a femoral stem adapted to bebonded to the patient's femur, where the femoral stem includes a ballcomponent at its proximal end received within the acetabular cupassembly to form a ball joint type coupling; and, a constraining ringhaving a central aperture, mounted to a rim of the acetabular cupassembly so that the femoral stem passes through the central aperture,where the diameter of the central aperture is less than the diameter ofthe ball component on the proximal end of the femoral stem so that thering assists in maintaining the ball joint type coupling between theacetabular cup assembly and the femoral stem, and where the constrainingring comprises a biologic material, a biologically reabsorbablematerial, or a combination of biologic and biologically reabsorbablematerials.

[0011] It is a third aspect of the present invention to provide aprosthetic constraining device for implantation in proximity to a hipjoint that includes an arcuate body defining a central aperture forallowing a femoral component to extend therethrough, where the arcuatebody includes a distal surface having at least one depression extendingradially thereacross to provide an increased range of angular motion ofthe femoral component, and including a proximal surface adapted to bemounted to an acetabular prosthesis, an acetabular bone, and/or aninnominate bone to help prevent a femoral head of the femoral componentfrom completely passing distally through the aperture.

[0012] It is a fourth aspect of the present invention to provide aconstraining device for, at least temporarily, maintaining engagement ofa prosthetic femoral stem component with a prosthetic acetabularcomponent of a prosthetic hip assembly, where the constraining devicecomprises a biologic material, a biologically reabsorbable material, ora combination of biologic and biologically reabsorbable materials.

[0013] It is a fifth aspect of the present invention to provide animplantable constraining device for, at least temporarily, maintainingthe integrity of a hip joint, where the constraining device comprises abiologic material, a biologically reabsorbable material, or acombination of biologic and biologically reabsorbable materials.

[0014] It is a sixth aspect of the present invention to provide aconstraining device for implantation in proximity to a hip joint thatincludes a plate comprising at least one biologically reabsorbablematerial, having an aperture extending therethrough for allowing afemoral component to extend therethrough, where the plate includes adistal surface having at least one depression accommodating an increasedrange of angular motion of the femoral component, and includes aproximal surface adapted to be mounted to an acetabular prosthesis, anacetabular bone, and/or an innominate bone to assist in inhibiting afemoral head of the femoral component from completely passing distallythrough the aperture.

[0015] A seventh aspect of the present invention is directed to a methodfor providing at least temporary stability to a prosthetic hip jointwhich includes an acetabular cup assembly bonded to a patient's pelvisand a femoral stem bonded to the patient's femur, where the femoral stemincludes a ball component at its proximal end received within theacetabular cup assembly to form a ball joint type coupling. The methodincludes the step of mounting a constraining device to the prosthetichip joint to provide stability to the prosthetic hip joint, where theconstraining device comprises a biologic material, a biologicallyreabsorbable material, or a combination of biologic and biologicallyreabsorbable materials.

BRIEF DESCRIPTIONS OF THE DRAWINGS

[0016]FIG. 1 is a perspective view of a prior art femoral prosthesisfitted within a prior art acetabulum prosthesis.

[0017]FIG. 2 is a side representative view of a prior art acetabulumprosthesis implanted within the pelvis;

[0018]FIG. 3 is a cross-sectional, side elevational view taken alonglines 3-3 of FIG. 4;

[0019]FIG. 4 is a top plan view of a first exemplary embodiment of thepresent invention;

[0020]FIG. 5 is a perspective view of the first exemplary embodiment ofthe present invention being mounted to the acetabular prosthetic cup;

[0021]FIG. 6 is a top plan view of one of many possible alternateconfigurations for the first exemplary embodiment of the presentinvention;

[0022]FIG. 7 is a perspective view of a second exemplary embodiment ofthe present invention mounted to the acetabular prosthetic cup and thefemoral component; and

[0023]FIG. 8 is a sectional view of a third exemplary embodiment of thepresent invention positioned in proximity to the acetabular prostheticcup and the femoral component.

[0024]FIG. 9 is a cross sectional view of an alternate exemplaryembodiment of the present invention positioned in proximity to theacetabular prosthetic cup and the femoral component.

DESCRIPTION OF THE PRESENT INVENTION

[0025] The exemplary embodiments described herein relate to constrainingdevices, materials and techniques for use in hip replacement surgery. Itwill, of course, be apparent to those of ordinary skill in the art thatthe devices, materials and techniques disclosed herein may be useful forother types of implants and orthopedic surgeries.

[0026] As shown in FIGS. 3-5, a first exemplary embodiment of thepresent invention is a constraining ring 24 adapted to be mounted on adistal end of the acetabular shell 10 (see FIG. 5) for maintaining theball 22 of the femoral component 14 within the acetabular shell 10. Theconstraining ring 24 is comprises a biologic and/or a biologicallyreabsorbable material that provides temporary stability to the hip jointfor varying times until live tissue (such as scar tissue) forms andreplaces the biologic and/or biologically reabsorbable material orstability is achieved through normal host compensatory mechanisms.

[0027] In an exemplary procedure, a physician would position theconstraining ring 24 around the neck of the femoral component 14 andthereafter attach the ball 22 to the end of the neck of the femoralcomponent 14. This effectively maintains the position of theconstraining ring 24 between the ball 22 and the base of the neck, asthe cross section of the opening of the constraining ring 24 does notaccommodate throughput of the ball 22 or the base of the neck of thefemoral component 14. After the physician has seated the ball 22 in theacetabular insert 20, the constraining ring 24 is mounted onto thedistal rim of the acetabular shell 10 with reabsorbable fasteners, suchas, without limitation, clips, snaps, screws, sutures, and rivets 26. Itis likewise possible that the constraining ring 24 be mounted to theacetabular bone or the innominate bone, or to the acetabular insert 20.The constraining ring 24 acts to inhibit post-operative dislocation ofthe ball 22 from the acetabular shell 10.

[0028] The reabsorbable constraining ring 24 of this exemplaryembodiment includes angled cut out regions 28 (or cut-away regions)formed into the distal end of the constraining ring 24 and positionedradially on the anterior/superior and posterior/superior portions of theconstraining ring 24 to improve range of motion for the femoralcomponent 14, while inhibiting dislocation. Typically, these cut outregions 28 would be positioned anteriorly to mitigate posteriordislocation when the hip is flexed and internally rotated. Conversely,these cut out regions 28 may be located posteriorly to mitigate anteriordislocation by inhibiting posterior impingement when the hip isexternally rotated and extended. Further, the constraining ring 24 mayalso have an elevation(s) 29 that may be positioned to further augmentstability. The interior surface of the constraining ring 24 may becontoured to better approximate the contour of the ball 22, exhibitinggenerally greater cross section from proximal to distal end. In otherwords, the constraining ring 24 includes an inner surface that issubstantially dome-shaped terminating at the aperture and having adiameter that narrows with the distance away from the proximal surfaceof the constraining ring 24.

[0029] In this exemplary embodiment, the constraining ring 24 will beabsorbed over a relatively short period (i.e., several weeks or months)and be replaced by tissue (such as scar tissue) that provides forlong-term hip stability and, hopefully, normal range of motion.

[0030] Examples of biologic materials for use with the constraining ring24 include, without limitation, extra cellular matrices (ECMs). Examplesof ECMs include, without limitation, porcine small intestine submucosa(SIS), xenogeneic small intestine submucosa (xSIS), urinary bladdersubmucosa (UBS), laminated intestinal submucosa, glutaraldehyde-treatedbovine pericardium (GLBP). The biologic materials may be layered,molded, formed, braided, perforated, multilaminated, grafted orotherwise manipulated to achieve the desired properties and dimensionsassociated with the constraining ring 24.

[0031] Examples of biologically reabsorbable materials for use with theconstraining ring 24 include, without limitation, MONOCRYL(poliglecaprone 25), PDS II (polydioxanone), surgical gut suture (SGS),gut, coated VICRYL (polyglactin 910, polyglactin 910 braided), humanautograft tendon material, collagen fiber, POLYSORB, poly-L-lactic acid(PLLA), polylactic acid (PLA), polylactides (Pla), racemic form ofpolylactide (D,L-Pla), poly(L-lactide-co-D,L-lactide), 70/30poly(L-lactide-co-D,L-lactide), polyglycolides (PGa), polyglycolic acid(PGA), polycaprolactone (PCL), polydioxanone (PDS), polyhydroxyacids,and resorbable plate material (see e.g. Orthopedics, October 2002, Vol.25, No. 10/Supp.). The biologically reabsorbable materials may belayered, molded, formed, braided, perforated, multilaminated, grafted orotherwise manipulated to achieve the desired properties and dimensionsassociated with the constraining ring 24. For example, the MONOCRYL(poliglecaprone 25), PDS II (polydioxanone), and resorbable platematerials may be block formed, while the surgical gut suture (SGS), gut,coated VICRYL (polyglactin 910), human autograft tendon material,collagen fiber, POLYSORB, poly-L-lactic acid (PLLA), polylactic acid(PLA), polyglycolic acid, and porcine small intestinal submucosa (SIS)material may be layered and formed. It is within the scope and spirit ofthe present invention that any of the above materials and techniques maybe used individually, alternatively, or in conjunction to produce theconstraining ring 24.

[0032] Exemplary materials comprising the biologically reabsorbablescrews 26 include, without limitation, poly-L-lactic acid (PLLA) andcollagen. As will be apparent to those of ordinary skill in the art,there are many other biologic and/or biologically reabsorbable materialsthat can be used for the constraining ring 24 or screws 26, all of whichand others developed hereafter fall within the scope of the invention.

[0033] It is also within the scope of the present invention to “load”(disburse, coat, impregnate, etc.) the biologic and/or biologicallyreabsorbable material comprising the constraining ring 24 with agentsthat could hasten or assist in tissue development, prevent unwanted boneformation (including heterotopic ossification), and/or fight infection.Exemplary agents include, for example, without limitation, concentratedplatelets (SYMPHONY from Depuy Orthapedic) and gentamicin.

[0034]FIG. 6 illustrates an alternate exemplary embodiment of theconstraining ring 24, having an alternate screw-hole 34 pattern, angledcut out region 28 pattern, and elevation 29 pattern.

[0035] In another alternate exemplary embodiment, as shown in FIG. 7,biologic and/or biologically reabsorbable mesh or webbing 30 could beused to hold the mid-neck region of the femoral component 14 to theacetabular shell 10 or to the acetabulum. Examples of biologic andbiologically reabsorbable mesh or webbing materials for use in thepresent embodiment include, without limitation, extra cellular matrices(ECMs). Examples of ECMs include, without limitation, porcine smallintestine submucosa (SIS), xenogeneic small intestine submucosa (xSIS),urinary bladder submucosa (UBS), laminated intestinal submucosa,glutaraldehyde-treated bovine pericardium (GLBP), VICRYL (polyglactin910), collagen, and natural gut. (See e.g. Tissue Engineering, February2002, pp. 63-71; Tissue Engineering, June 2001, pp. 321-34; J. Biomed.Material Resources, November 2000, pp. 365-73; J Biomed MaterialResources, July 2001, pp. 101-8; Arthroscopy, February 2001, pp. 151-9;Endothelium, 2001, pp. 11-24; Biomaterials, October 2001, pp. 2653-9; J.Surg. Res., August 1997, pp. 179-86). By way of example, porcine smallintestinal submucosa (SIS) may act as scaffolding for ingrowth ofconnecter tissue between the acetabular shell 10 and femoral component14. The mesh 30 may be attached between the femur and/or femoralcomponent 14 (including the neck and ball 22) and at least one of theconstraining ring 24, acetabular shell 10, acetabular insert 20, orsurrounding bone. Attachment of the mesh 30 to any of the abovecomponents could be accomplished by way of suture, suture anchor, screw,rivet, or any other effective fastening mechanism or procedure. Anexemplary mounting procedure might include a circumferential channelwithin the neck of the femoral component 14 being lined by a sutureincorporated into the mesh 30, with the suture drawn taught around theneck of the femoral component 14 mounting the mesh 30 thereto. Oppositethe femoral component, the mesh 30 may be mounted to the acetabularinsert 20 of the acetabular shell 10 with suture anchors. The mesh 30may be used separately or in combination with the constraining ring 24discussed above. Again, it will be apparent to those of ordinary skillin the art there are many other biologic and/or biologicallyreabsorbable materials that can comprise the mesh 30, all of whichcurrently developed and hereafter developed fall within the scope of theinvention.

[0036] Another exemplary embodiment, as shown in FIG. 8, includes abiologically reabsorbable paste/glue 32 that rapidly converts intotissue (such as scar tissue). The paste/glue 32 is directed in proximityto the neck of the prosthesis and acetabulum and allows patients todecrease the time that they would need to abide by their post-operativehip precautions (such as no tying shoes, donning socks or toenail care).Typically, these precautions prevent the patient from doing anyactivities that require greater hip flexion than 90°. Examples ofmaterials comprising the biologically reabsorbable paste 32 of thepresent invention include, for example, without limitation, porcinesmall intestinal submucosa (SIS) and VICRYL (polyglactin 910). The useof SIS, for example, in a paste form positioned in proximity to the neckregion of the prosthesis nearing the end of the arthroplasty couldstimulate more rapid tissue formation and substantially decrease thetime period before patients could return to normal activities of dailyliving. It is also within the scope of the invention that agents such asantibiotics and/or clotting agents discussed above could also be addedto the paste 32 to decrease the risk of infection in a similar fashionas physicians presently impregnate cement with antibiotics. The paste 32enables efficient direct delivery of prophylactic antibiotics to the hipjoint.

[0037] Referencing FIG. 9, a fourth exemplary embodiment of the presentinvention includes a constraining ring 24′ having a bladder 34manipulatable to arrive at the cut out regions and the elevations 29′for inhibiting dislocation of the ball 22 from the acetabular insert 20.The constraining is attached to at least one of the acetabular shell,acetabular bone, or to the acetabular insert, through various forms ofattachment discussed above, including rivets 26. The bladder 34 may beconfigured to receive a reabsorbable fluid material injected thereinthat rapidly transitions to a solid state, thereby expanding at certainlocations to provide one or more elevations 29′, and providing little orno expansion to accommodate one or more cut out regions. The transitiontime between liquid and solid state may further enable a physician tocustom mold the bladder 34 to inhibit luxation and minimize impingement.Likewise, the constraining ring 24′ may have a plurality of bladders 34to create two or more elevations 29′. It is within the scope of theinvention that the bladder 34 be porous, biologic or biologicallyabsorbable, or a combination of these. Further, it is within the scopeof the invention that the bladder 34 and/or the contents include one ormore agents to promote tissue formation, fight infection, and promoteclotting.

[0038] With each of the above embodiments, it is within the scope of theinvention to incorporate growth stimulating factors with the biologic orbiologically reabsorbable materials. These could be incorporated into abioreabsorbable paste or moldable scaffolding to provide a threedimensional framework for the creation of tissue engineered scar massinhibiting dislocation of the femoral component 14. Examples of suchgrowth stimulating factors include, without limitation, growth factorbeta (GFB-β), basic fibroblast growth factor (bFGF), fibroblast growthfactor (FGF), epidermal growth factor (EFG), transforming growthfactor-β1 (TGF-β1), vascular endothelial growth factor (VEGF),connective tissue growth factor (CTGF), platelet-derived growth factor(PDGF), direct-mediated gene transfer, fibroblast-mediated genetransfer, myoblast-mediated gene transfer, TGF-β gene family,adenovirus-mediated gene transfer, recombinant adenovirus-induced tendonadhesion formation, BMP-12, bone morphogenetic protein-2 gene transfer,growth and differentiation factor-5 (GDF-5) and, insulin like growthfactor (IFG). (See e.g. Koski et al., “Tissue-Engineered Ligament—Cells,Matrix, and Growth Factors”, July 2000 Tissue Engineering in OrthopedicSurgery, Volume 31, No. 3), (see e.g., Boyer, “Using Growth Factors toEnhance Tendon and Ligament Repair”, Orthopaedic Research SocietySymposia, AAOS Annual Meeting New Orleans February 2003). Several ofthese growth factors have been proposed as possible mitogens infibroblast growth.

[0039] It is also within the scope of the invention to incorporateconnective tissue stem cells and progenitors with the biologic orbiologically reabsorbable materials disclosed in the above embodiments.These connective tissue stem cells and progenitors may be incorporatedinto a bioreabsorbable paste 32 or moldable scaffolding to provide athree dimensional framework for the creation of engineered tissue for,in an exemplary application, inhibiting dislocation of the femoralcomponent 14. Examples of such connective tissue stem cells andprogenitors include, without limitation, fibroblastic colony-formingcells, fibroplast colony-forming units (CFU-F), bone marrow stromalcells, mesenchymal stem cells (MSC), and vascular pericytes. (See e.g.Meschler et al. “Connective Tissue Progenitors: Practical Concepts forClinical Applications”, 2002 Clinical Orthopaedics and Related Research,No. 395, pp. 66-80).

[0040] It is also within the scope of the invention to incorporatehematopoietic stem cells and progenitors with the biologic orbiologically reabsorbable materials disclosed in the above embodiments.These hematopoietic stem cells and progenitors may be incorporated intoa reabsorbable paste or moldable scaffolding to provide any cell makingup circulating blood and the immune system for, in an exemplaryapplication, inhibiting infection after surgery.

[0041] It is also within the scope and spirit of the present inventionto provide a constraining ring 24 as described herein comprising abiologically non-absorbable material, such as, without limitation,polymers, metals, ceramics, resins, and composites.

[0042] Constraining rings 24 comprising biologically non-absorbablematerials may be mounted in a like manner as a reabsorbable constrainingring, but with non-absorbable fasteners, such as, without limitation,clips, snaps, screws, sutures, glues or rivets. These non-absorbableconstraining rings 24 may have a planar distal surface that includes oneor more depressions positioned axially thereabout for increasing theangular range of motion of the femoral component 14. In such aconfiguration, the axial range of motion of the femoral component 14 maybe maintained in all 360° without substantially changing the amount ofsurface area in contact between the neck of the femoral component 14 andthe distal surface of the constraining ring 24. Such constraining rings24 may also include elevations 29 as discussed above.

[0043] It is additionally within the scope and spirit of the presentinvention to provide a constraining ring 24 comprising a biologic,biologically reabsorbable, and/or biologically non-absorbable materialthat allows a physician to manipulate the cut out regions 28 and theelevations 29 approximate the cut out regions 28 before and duringsurgery to better accommodate the patient's unique biomechanics as aresult of the hip surgery. An exemplary embodiment may enablemanipulation of the elevations 29 and cut out regions 28 by providing akeyway with segmented elevations 29 and cut out regions 28 movingtherein. Likewise, an exemplary elevation 29 might be manipulatable bymounting a biologic, biologically reabsorbable, and/or biologicallynon-absorbable material in the form of a contoured augment onto thedistal surface of the constraining ring 24. It is likewise within thescope and spirit of the present invention to allow a physician tomanipulate the dimensions and locations of biologic and/or biologicallyreabsorbable fasteners (such as a clip, snap, screw, suture, keyway, orrivet) utilized to secure the constraining ring 24, elevations 29, ormesh 30 to any of the above structural components.

[0044] It is further within the scope and spirit of the presentinvention to provide a constraining ring 24 having a non-circularaperture. Likewise it is within the scope and spirit of the presentinvention to provide a constraining ring 24 having a non-circular crosssection.

[0045] Following from the above description and invention summaries, itshould be apparent to those of ordinary skill in the art that, while theapparatuses and methods herein described constitute exemplaryembodiments of the present invention, it is to be understood that theinventions contained herein are not limited to these precise embodimentsand that changes may be made to them without departing from the scope ofthe inventions as defined by the claims. Additionally, it is to beunderstood that the invention is defined by the claims and it is notintended that any limitations or elements describing the exemplaryembodiments set forth herein are to be incorporated into the meanings ofthe claims unless such limitations or elements are explicitly listed inthe claims. Likewise, it is to be understood that it is not necessary tomeet any or all of the identified advantages or objects of the inventiondisclosed herein in order to fall within the scope of any claims, sincethe invention is defined by the claims and since inherent and/orunforeseen advantages of the present invention may exist even thoughthey may not have been explicitly discussed herein.

What is claimed is:
 1. A prosthetic constraining device for use with ahip replacement prosthesis that includes an acetabular cup assemblyadapted to be bonded to a patient's pelvis and a femoral stem adapted tobe bonded to the patient's femur, where the femoral stem includes a ballcomponent at its proximal end received within the acetabular cupassembly to form a ball joint type coupling, the constraining devicecomprising: a ring having a central aperture, the ring being adapted tobe mounted to a rim of the acetabular cup assembly so that the femoralstem passes through the central aperture, the diameter of the centralaperture being less than the diameter of the ball component on theproximal end of the femoral stem so that the ring assists in maintainingthe ball joint type coupling between the acetabular cup assembly and thefemoral stem; the ring comprises a ring material taken from the groupconsisting of a biologic material, a biologically reabsorbable material,and a combination of biologic and biologically reabsorbable materials.2. The prosthetic constraining device of claim 1, further comprising aplurality of fasteners for mounting the ring to the rim of theacetabular cup assembly, wherein the fasteners comprise a fastenermaterial taken from the group consisting of a biologic material, abiologically reabsorbable material, and a combination of biologic andbiologically reabsorbable materials.
 3. The prosthetic constrainingdevice of claim 2, wherein the fastener material includes at least one,or an equivalent, of: a poly-L-lactic acid material; and collagen. 4.The prosthetic constraining device of claim 2, wherein the fasteners aretaken from the group consisting of screws, snaps, sutures, clips, andrivets.
 5. The prosthetic constraining device of claim 1, wherein thering material includes at least one, or an equivalent, of: extracellular matrices (ECMs); poliglecaprone 25; polydioxanone; surgical gutsuture (SGS); gut; polyglactin 910; human autograft tendon material;collagen fiber; poly-L-lactic acid (PLLA); polylactic acid (PLA);polylactides (Pla); racemic form of polylactide (D,L-Pla);poly(L-lactide-co-D,L-lactide); polyglycolides (PGa); polyglycolic acid(PGA); polycaprolactone (PCL); polydioxanone (PDS); polyhydroxyacids;and resorbable plate material
 6. The prosthetic constraining device ofclaim 5, wherein the extra cellular matrices (ECMs) includes at leastone of: porcine small intestine submucosa (SIS); xenogeneic smallintestine submucosa (xSIS); urinary bladder submucosa (UBS); laminatedintestinal submucosa; and glutaraldehyde-treated bovine pericardium(GLBP).
 7. The prosthetic constraining device of claim 1, wherein thering includes a distal surface having at least a first depressionextending radially thereacross to provide an increased range of angularmotion of the femoral stem.
 8. The prosthetic constraining device ofclaim 7, wherein the first depression is located in at least one of theanterior/superior and posterior/superior regions of the ring when thering is mounted to the acetabular cup assembly.
 9. The prostheticconstraining device of claim 8, wherein the distal surface of the ringhas at least a second depression extending radially thereacross toprovide increased range of angular motion of the femoral stem in atleast two directions.
 10. The prosthetic constraining device of claim 9,wherein the first depression is located in the anterior/superior regionand the second depressions is located in posterior/superior region ofthe ring when the ring is mounted to the one acetabular cup assembly.11. The prosthetic constraining device of claim 10, wherein the apertureincludes an inner surface that is substantially dome-shaped, having adiameter that narrows with the distance from the proximal surface of thering.
 12. The prosthetic constraining device of claim 7, wherein thecircumferential width of the first depression is at least slightlylarger than a diameter of a neck of the femoral stem.
 13. The prostheticconstraining device of claim 7, wherein the distal surface of the ringfurther includes an elevated section to reduce angular movement of thefemoral stem in the radial direction of the elevated section.
 14. Theprosthetic constraining device of claim 13, wherein the elevated sectionis located in the posterior region of the ring when the constrainingdevice is mounted to the acetabular cup assembly.
 15. The prostheticconstraining device of claim 7, wherein the aperture includes an innersurface that is substantially dome-shaped, having a diameter thatnarrows with the distance from the proximal surface of the ring.
 16. Theprosthetic constraining device of claim 1, wherein the ring material isloaded with an agent to promote the formation of scar tissue.
 17. Theprosthetic constraining device of claim 1, wherein the ring material isloaded with an antibacterial agent.
 18. The prosthetic constrainingdevice of claim 1, wherein the ring material is loaded with an agent tolimit the formation of bone tissue.
 19. The prosthetic constrainingdevice of claim 1, wherein the ring material is loaded with at least oneof connective tissue stem cells and connective tissue stem cellprogenitors.
 20. The prosthetic constraining device of claim 19, whereinthe connective tissue stem cells and connective tissue stem progenitorsare taken from the group consisting of: fibroblastic colony-formingcells, fibroplast colony-forming units (CFU-F), bone marrow stromalcells, mesenchymal stem cells (MSC), and vascular pericytes.
 21. Theprosthetic constraining device of claim 1, wherein the ring material isloaded with a growth stimulating factor.
 22. The prosthetic constrainingdevice of claim 21, wherein the growth stimulating factor is taken fromthe group consisting of: growth factor beta (GFB-β), basic fibroblastgrowth factor (bFGF), fibroblast growth factor (FGF), epidermal growthfactor (EFG), transforming growth factor-β1 (TGF-β1), vascularendothelial growth factor (VEGF), connective tissue growth factor(CTGF), platelet-derived growth factor (PDGF), direct-mediated genetransfer, fibroblast-mediated gene transfer, myoblast-mediated genetransfer, TGF-β gene family, adenovirus-mediated gene transfer,recombinant adenovirus-induced tendon adhesion formation, BMP-12, bonemorphogenetic protein-2 gene transfer, growth and differentiationfactor-5 (GDF-5), and insulin like growth factor (IFG).
 23. Theprosthetic constraining device of claim 1, wherein the ring material isloaded with at least one of hematopoietic stem cells and hematopoieticstem cells progenitors.
 24. The prosthetic constraining device of claim1, further comprising a bladder operatively coupled to the ring.
 25. Theprosthetic constraining device of claim 24, wherein the bladder isporous and adapted to contain at least one of a clotting agent, anantibiotic agent, and a scar tissue promoter.
 26. The prostheticconstraining device of claim 24, wherein the bladder is reabsorbable andcontains at least one of a clotting agent, an antibiotic agent, and ascar tissue promoter.
 27. A prosthetic hip prosthesis comprising: anacetabular cup assembly adapted to be bonded to a patient's pelvis; afemoral stem adapted to be bonded to the patient's femur, the femoralstem including a ball component at its proximal end received within theacetabular cup assembly to form a ball joint type coupling; and aconstraining ring having a central aperture, mounted to a rim of theacetabular cup assembly so that the femoral stem passes through thecentral aperture, the diameter of the central aperture being less thanthe diameter of the ball component on the proximal end of the femoralstem so that the ring assists in maintaining the ball joint typecoupling between the acetabular cup assembly and the femoral stem; theconstraining ring comprises a ring material taken from the groupconsisting of a biologic material, a biologically absorbable material,and a combination of biologic and biologically reabsorbable materials.28. The prosthetic hip prosthesis of claim 27, further comprising aplurality of fasteners mounting the constraining ring to the rim of theacetabular cup assembly, wherein the fasteners comprise a fastenermaterial taken from the group consisting of a biologic material, abiologically reabsorbable material, and a combination of biologic andbiologically reabsorbable materials.
 29. The prosthetic hip prosthesisof claim 27, wherein the constraining ring includes a distal surfacehaving at least a first depression extending radially thereacross toprovide an increased range of angular motion of the femoral stem. 30.The prosthetic hip prosthesis of claim 29, wherein the first depressionis located in at least one of the anterior/superior andposterior/superior regions of the constraining ring.
 31. The prosthetichip prosthesis of claim 30, wherein the distal surface of theconstraining ring has at least a second depression extending radiallythereacross to provide increased range of angular motion of the femoralstem in at least two directions.
 32. The prosthetic hip prosthesis ofclaim 31, wherein the first depression is located in theanterior/superior region and the second depressions is located inposterior/superior region of the constraining ring.
 33. The prosthetichip prosthesis of claim 32, wherein the aperture includes an innersurface that is substantially dome-shaped, having a diameter thatnarrows with the distance from the proximal surface of the constrainingring.
 34. The prosthetic hip prosthesis of claim 27, wherein the distalsurface of the constraining ring further includes an elevated section toreduce angular movement of the femoral stem in the radial direction ofthe elevated section.
 35. The prosthetic hip prosthesis of claim 34,wherein the elevated section is located in the posterior region of theconstraining ring.
 36. The prosthetic hip prosthesis of claim 27,wherein the ring material is loaded with an agent to promote theformation of scar tissue.
 37. The prosthetic hip prosthesis of claim 27,wherein the ring material is loaded with an antibacterial agent.
 38. Theprosthetic hip prosthesis of claim 27, wherein the ring material isloaded with an agent to limit the formation of bone tissue.
 39. Aprosthetic constraining device for implantation in proximity to a hipjoint, comprising an arcuate body defining a central aperture forallowing a femoral component to extend therethrough, the arcuate bodyincluding a distal surface having at least one depression extendingradially thereacross to provide an increased range of angular motion ofthe femoral component, and including a proximal surface adapted to bemounted to at least one of an acetabular prosthesis, an acetabular bone,and an innominate bone to prevent a femoral head of the femoralcomponent from completely passing distally through the aperture.
 40. Theconstraining device of claim 39, wherein the depression is located in atleast one of an anterior/superior and posterior/superior region of thearcuate body when the constraining device is mounted to the oneacetabular prosthesis, acetabular bone and innominate bone.
 41. Theconstraining device of claim 40, wherein the distal surface has at leasttwo of the depressions extending radially thereacross to provideincreased range of angular motion of the femoral component in at leasttwo directions.
 42. The constraining device of claim 41, wherein thefirst depression is located in the anterior/superior region and thesecond depression is located in the posterior/superior region of thearcuate body when the constraining device is mounted to the oneacetabular prosthesis, acetabular bone and innominate bone.
 43. Theconstraining device of claim 41, wherein the arcuate body issubstantially annular.
 44. The constraining device of claim 43, whereinthe aperture includes an inner surface that is substantiallydome-shaped, having a diameter that narrows with the distance from theproximal surface of the arcuate body.
 45. The constraining device ofclaim 44, wherein the depression includes a step change in height withrespect to the distal surface of the arcuate body.
 46. The constrainingdevice of claim 39, wherein the proximal surface of the arcuate body isadapted to be mounted to an acetabular prosthesis component, and thecomposition of material comprising the arcuate body and the acetabularprosthesis component are substantially the same.
 47. The constrainingdevice of claim 39, wherein the circumferential width of the depressionis at least slightly larger than a diameter of a neck of the femoralcomponent.
 48. The constraining device of claim 39, wherein the distalsurface of the arcuate body further includes an elevated section toreduce angular movement of the femoral component in the radial directionof the elevated section.
 49. The constraining device of claim 48,wherein the elevated section is located in the posterior region of thearcuate body when the constraining device is mounted to the oneacetabular prosthesis, acetabular bone and innominate bone.
 50. Theconstraining device of claim 39, wherein the arcuate body issubstantially annular.
 51. The constraining device of claim 39, whereinthe aperture includes an inner surface that is substantiallydome-shaped, having a diameter that narrows with the distance from theproximal surface of the arcuate body.
 52. The constraining device ofclaim 39, wherein the proximal surface of the arcuate body is adapted tobe mounted to an acetabular prosthesis component, and the composition ofmaterial comprising the arcuate body and the acetabular prosthesiscomponent are substantially the same.
 53. A constraining device for, atleast temporarily, maintaining engagement of a prosthetic femoral stemcomponent with a prosthetic acetabular component of a prosthetic hipassembly, the constraining device comprises a material taken from thegroup consisting of a biologic material, a biologically reabsorbablematerial, and a combination of biologic and biologically reabsorbablematerials.
 54. The constraining device of claim 53, wherein the materialincludes at least one, or an equivalent, of: extra cellular matrices(ECMs); poliglecaprone 25; polydioxanone; surgical gut suture (SGS);gut; polyglactin 910; human autograft tendon material; collagen fiber;poly-L-lactic acid (PLLA); polylactic acid (PLA); polylactides (Pla);racemic form of polylactide (D,L-Pla); poly(L-lactide-co-D,L-lactide);polyglycolides (PGa); polyglycolic acid (PGA); polycaprolactone (PCL);polydioxanone (PDS); polyhydroxyacids; and resorbable plate material 55.The constraining device of claim 54, wherein the extra cellular matrices(ECMs) includes at least one of: porcine small intestine submucosa(SIS); xenogeneic small intestine submucosa (xSIS); urinary bladdersubmucosa (UBS); laminated intestinal submucosa; andglutaraldehyde-treated bovine pericardium (GLBP).
 56. The constrainingdevice of claim 53, wherein the material is in the form of aconstraining ring adapted to be mounted to a rim of an acetabular cupassembly the acetabular prosthesis component.
 57. The constrainingdevice of claim 53, wherein the material is in the form of a meshadapted to be attached between the acetabular prosthesis component andthe prosthetic femoral stem component.
 58. The constraining device ofclaim 53, wherein the material is in the form of a webbing adapted to beattached between the acetabular prosthesis component and the prostheticfemoral stem component.
 59. The constraining device of claim 53, whereinthe material is in the form of a band attached between the acetabularprosthesis component and the prosthetic femoral stem component.
 60. Theconstraining device of claim 53, wherein the material is adapted to besubstantially absorbed by a patient's body after implantation and to besubstantially replaced by scar tissue.
 61. The constraining device ofclaim 60, wherein the material is adapted to be substantially absorbedand replaced by scar tissue within approximately 6 months afterimplantation.
 62. The constraining device of claim 53, wherein thematerial is loaded with an antibacterial agent.
 63. The constrainingdevice of claim 53, wherein the material is loaded with a clottingagent.
 64. An implantable constraining device for, at least temporarily,maintaining integrity of a hip joint, the constraining device comprisesa material taken from the group consisting of a biologic material, abiologically reabsorbable material, and a combination of biologic andbiologically reabsorbable materials.
 65. The implantable constrainingdevice of claim 64, wherein the material is in the form of a meshadapted to be attached between the hip bone and the femur.
 66. Theconstraining device of claim 64, wherein the material is in the form ofa webbing adapted to be attached between the hip bone and the femur. 67.The constraining device of claim 64, wherein the material is in the formof a band attached between the hip bone and the femur.
 68. Theconstraining device of claim 64, wherein the material is adapted to besubstantially absorbed by a patient's body after implantation and to besubstantially replaced by scar tissue.
 69. The constraining device ofclaim 68, wherein the material is adapted to be substantially absorbedand replaced by scar tissue within approximately 6 months afterimplantation.
 70. The constraining device of claim 64, wherein thematerial is loaded with an antibacterial agent.
 71. The constrainingdevice of claim 64, wherein the material is loaded with a clottingagent.
 72. The constraining device of claim 64, wherein the material isloaded with an agent to promote the formation of scar tissue.
 73. Theconstraining device of claim 64, wherein the material is loaded with anagent to limit the formation of bone tissue.
 74. The prostheticconstraining device of claim 64, wherein the material is loaded with atleast one of connective tissue stem cells and connective tissue stemcell progenitors.
 75. The prosthetic constraining device of claim 74,wherein the connective tissue stem cells and connective tissue stemprogenitors are taken from the group consisting of: fibroblasticcolony-forming cells, fibroplast colony-forming units (CFU-F), bonemarrow stromal cells, mesenchymal stem cells (MSC), and vascularpericytes.
 76. The prosthetic constraining device of claim 64, whereinthe material is loaded with a growth stimulating factor.
 77. Theprosthetic constraining device of claim 76, wherein the growthstimulating factor is taken from the group consisting of: growth factorbeta (GFB-β), basic fibroblast growth factor (bFGF), fibroblast growthfactor (FGF), epidermal growth factor (EFG), transforming growthfactor-β1 (TGF-β1), vascular endothelial growth factor (VEGF),connective tissue growth factor (CTGF), platelet-derived growth factor(PDGF), direct-mediated gene transfer, fibroblast-mediated genetransfer, myoblast-mediated gene transfer, TGF-β gene family,adenovirus-mediated gene transfer, recombinant adenovirus-induced tendonadhesion formation, BMP-12, bone morphogenetic protein-2 gene transfer,growth and differentiation factor-5 (GDF-5), and insulin like growthfactor (IFG).
 78. The prosthetic constraining device of claim 64,wherein the material is loaded with at least one of hematopoietic stemcells and hematopoietic stem cells progenitors.
 79. A constrainingdevice for implantation in proximity to a hip joint, including a platecomprising at least one biologically reabsorbable material, having anaperture extending therethrough for allowing a femoral component toextend therethrough, the plate including a distal surface having atleast one depression accommodating an increased range of angular motionof the femoral component, and a proximal surface adapted to be mountedto at least one of an acetabular prosthesis, an acetabular bone, and aninnominate bone to inhibit a femoral head of the femoral component fromcompletely passing distally through the aperture.
 80. The constrainingdevice of claim 79, further comprising a biologically reabsorbable meshmounted in proximity to the femoral component at a first location andmounted in proximity to at least one of an acetabular prosthesis, anacetabular bone, and an innominate bone at a second location.
 81. Theconstraining device of claim 79, wherein the biologically reabsorbablematerial is loaded with a clotting agent.
 82. The constraining device ofclaim 79, wherein the biologically reabsorbable material is loaded withantibiotic agent.
 83. The constraining device of claim 79, wherein thebiologically reabsorbable material is loaded with an agent to promotethe formation of scar tissue.
 84. The constraining device of claim 79,wherein the biologically reabsorbable material is loaded with an agentto limit the formation of bone tissue.
 85. The prosthetic constrainingdevice of claim 79, wherein the biologically reabsorbable material isloaded with at least one of connective tissue stem cells and connectivetissue stem cell progenitors.
 86. The prosthetic constraining device ofclaim 85, wherein the connective tissue stem cells and connective tissuestem progenitors are taken from the group consisting of: fibroblasticcolony-forming cells, fibroplast colony-forming units (CFU-F), bonemarrow stromal cells, mesenchymal stem cells (MSC), and vascularpericytes.
 87. The prosthetic constraining device of claim 79, whereinthe biologically reabsorbable material is loaded with a growthstimulating factor.
 88. The prosthetic constraining device of claim 87,wherein the growth stimulating factor is taken from the group consistingof: growth factor beta (GFB-β), basic fibroblast growth factor (bFGF),fibroblast growth factor (FGF), epidermal growth factor (EFG),transforming growth factor-β1 (TGF-β1), vascular endothelial growthfactor (VEGF), connective tissue growth factor (CTGF), platelet-derivedgrowth factor (PDGF), direct-mediated gene transfer, fibroblast-mediatedgene transfer, myoblast-mediated gene transfer, TGF-β gene family,adenovirus-mediated gene transfer, recombinant adenovirus-induced tendonadhesion formation, BMP-12, bone morphogenetic protein-2 gene transfer,growth and differentiation factor-5 (GDF-5), and insulin like growthfactor (IFG).
 89. The prosthetic constraining device of claim 79,wherein the biologically reabsorbable material is loaded with at leastone of hematopoietic stem cells and hematopoietic stem cellsprogenitors.
 90. A method for providing at least temporary stability toa prosthetic hip joint which includes an acetabular cup assembly bondedto a patient's pelvis and a femoral stem bonded to the patient's femur,where the femoral stem includes a ball component at its proximal endreceived within the acetabular cup assembly to form a ball joint typecoupling, the method comprising the step of: mounting a constrainingdevice to the prosthetic hip joint to provide stability to theprosthetic hip joint, wherein the constraining device comprises amaterial taken from the group consisting of a biologic material, abiologically reabsorbable material, and a combination of biologic andbiologically reabsorbable materials.
 91. The method of claim 90, whereinthe constraining device has a substantially annular body defining anaperture, and wherein the mounting step includes the step of mountingthe constraining device about a rim of the acetabular cup assembly suchthat the femoral stem passes through the aperture.
 92. The method ofclaim 91, wherein the mounting step includes the step of fastening theconstraining device to the rim of the acetabular cup assembly withfasteners comprised of a material taken from the group consisting of abiologic material, a biologically reabsorbable material, and acombination of biologic and biologically reabsorbable materials.
 93. Themethod of claim 92, wherein the fasteners are taken from the groupconsisting of screws, snaps, sutures, clips, and rivets.
 94. The methodof claim 90, wherein the material is loaded with at least one of: anagent to promote formation of scar tissue, a clotting agent, and anantibacterial agent.
 95. The method of claim 90, wherein the material isadapted to be substantially absorbed by a patient's body after themounting step and to be substantially replaced by scar tissue.
 96. Themethod of claim 90, wherein the constraining device is in the form of amesh and the mounting step includes the steps of: attaching the mesh toat least one of the patient's femur and the femoral stem; and attachingthe mesh to at least one of the patient's pelvis and the acetabular cupassembly.
 97. The method of claim 90 wherein the constraining device isin the form of a webbing and the mounting step includes the steps of:attaching the webbing to at least one of the patient's femur and thefemoral stem; and attaching the webbing to at least one of the patient'spelvis and the acetabular cup assembly.
 98. The method of claim 90,wherein the constraining device is in the form of a band and themounting step includes the steps of: attaching the band to at least oneof the patient's femur and the femoral stem; and attaching the band toat least one of the patient's pelvis and the acetabular cup assembly.99. The method of claim 90, wherein the constraining device is in theform of a paste material and the mounting step includes the step ofapplying the paste material to at least a portion of the patient'sprosthetic hip joint.
 100. The method of claim 99, wherein the materialis loaded with at least one of: an agent to promote formation of scartissue, a clotting agent, and an antibacterial agent.
 101. The method ofclaim 100, wherein the material is adapted to be substantially absorbedby a patient's body after the mounting step and to be substantiallyreplaced by scar tissue.
 102. The method of claim 90, wherein theconstraining device includes a bladder comprising at least one ofreabsorbable material and non-reabsorbable material.
 103. The method ofclaim 102, wherein the constraining device includes a bladder includesat least one of a clotting agent, an antibiotic agent, and a scar tissuepromoter.
 104. The prosthetic constraining device of claim 90, whereinthe material is loaded with at least one of connective tissue stem cellsand connective tissue stem cell progenitors.
 105. The prostheticconstraining device of claim 104, wherein the connective tissue stemcells and connective tissue stem progenitors are taken from the groupconsisting of: fibroblastic colony-forming cells, fibroplastcolony-forming units (CFU-F), bone marrow stromal cells, mesenchymalstem cells (MSC), and vascular pericytes.
 106. The prostheticconstraining device of claim 90, wherein the material is loaded with agrowth stimulating factor.
 107. The prosthetic constraining device ofclaim 106, wherein the growth stimulating factor is taken from the groupconsisting of: growth factor beta (GFB-β), basic fibroblast growthfactor (bFGF), fibroblast growth factor (FGF), epidermal growth factor(EFG), transforming growth factorβ1 (TGF-β1), vascular endothelialgrowth factor (VEGF), connective tissue growth factor (CTGF),platelet-derived growth factor (PDGF), direct-mediated gene transfer,fibroblast-mediated gene transfer, myoblast-mediated gene transfer,TGF-β gene family, adenovirus-mediated gene transfer, recombinantadenovirus-induced tendon adhesion formation, BMP-12, bone morphogeneticprotein-2 gene transfer, growth and differentiation factor-5 (GDF-5),and insulin like growth factor (IFG).
 108. The prosthetic constrainingdevice of claim 90, wherein the material is loaded with at least one ofhematopoietic stem cells and hematopoietic stem cells progenitors.